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TSNRP

Evidence-based Operational Nursing Skills and Training

Care under fire is often our first thought when we consider operational medicine, nursing, and healthcare. However, the term operational is much broader and is directly associated with our mission, service, role, and environment. A submarine, aircraft, spacecraft, forward operating base, frontline, and disaster site are all operational settings. Health focuses in operational environments target preventing and treating operational stressors, injuries, and hazards, as well as enhancing member readiness and performance.


The operational trauma-focused evidence-based Clinical Practice Guidelines (CPG) produced by the Joint Trauma System (JTS) improve quality of care, reduce variance in clinical care and outcomes metrics (Spott et al., 2018). The JTS CPGs are used widely by multidisciplinary teams while they are primarily physician-centric. Find JTS CPGs at https://jts.health.mil/index.cfm/PI_CPGs/cpgs.


Until 2009 military nurses lacked a centralized resource for finding evidence-based operational nursing guidance. Military nurse scientists recognized a gap in operational nursing evidence prior to the inception (1992) of the TriService Nursing Research Program (TSNRP). Since that time, dedicated funding from TSNRP has supported military nursing research and dissemination of evidence to address existing military nursing gaps. The following examples illustrate how military operational nursing research develops evidence to inform and update nursing care skills and standards for the operational environment.


Research Evidence on Operational Nursing Skills

A multidisciplinary team of researchers explored 2007-2020 data from the Department of Defense Trauma Registry of US and North Atlantic Treaty Organization. Their clinical inquiry focused on investigating the most common operational nursing procedures performed by nurses and combat medics in prolonged field environments.


The investigation used the Army’s Individual Critical Task List (ICTL) for nurses, designed to sustain combat nursing readiness skills. The scientists organized the findings for commonly performed nursing procedures into pre-hospital settings (parenteral administration of opioids, dressing wounds, and ketamine administration) and deployed hospital setting (patient transfer preparation, post-operative, and traumatic brain injury patient management) (Wilson et al., 2022). Other commonly performed nursing procedures included in descending order: blood gas, ventilator management and administration of packed red blood cells (Wilson et al., 2022).


Evidence-based training tailored to unique operational environments is critical to ensure operational nursing competency, sustain readiness, and prevent skills decay. Efforts to identify (literature search), modify (integrate evidence into current training), or develop (use evidence to develop training) evidence-based training are all examples of Operational Nursing EBP.





Studying operational training scenarios provides research evidence associated with nursing readiness. For example, an assessment of Navy en route care training for interfacility patient transport was conducted using a high-fidelity medical simulation scenario (DeForest et al., 2018). After evaluating critical life-saving and secondary skills of healthcare teams, 98% of the team members did not perform all critical interfacility transfer skills. Most members completed at least one life-saving skill: 64% applied tourniquet, 51% performed needle decompression, 48% complete hand-off report, and 46% administered blood products (DeForest et al., 2018). Findings for performance of secondary skills revealed that 44% reinforced amputation site dressings and 24% accurately administered analgesics (DeForest et al., 2018).


Table-top and live simulation exercises provide an opportunity to evaluate performance and integrate evidence-based recommendations for improved training. A variety of courses are provided by the Defense Medical Readiness Training Institute (DMRTI) for military members to participate in operational skills training. Find Trauma Nursing Core Competency (TNCC), Combat Casualty Core Course (C4), Advanced Trauma Life Support (ATLS) and 29 other courses at https://www.health.mil/Military-Health-Topics/Education-and-Training/DMRTI/Course-Information.


Formal education courses are invaluable, however, to maintain operational skills continued practice is required. Local readiness training must continually seek and integrate new evidence-based recommendations into training platforms. Although knowledge, skills and abilities are established for Advanced Practice Nurses (APN), no formal operational curriculum is available for military APNs (D’Angelo et al., 2019).


Resources for Military Nurses

Get involved with searching for and implementing the best operational nursing evidence. To increase your awareness and implementation of evidence-based operational nursing skills, request a free consultation with an EBP Facilitator. TSNRP provides facilitators, located in military treatment facilities, to educate, guide, and provide tools for military nurses to implement evidence-based practice. Online EBP resources are also available.


Understanding the Military Health System burden of disease and conditions is critical for educating and implementing evidence-based solutions for our warfighters and beneficiaries.




References

  • D'Angelo, M. R., Seibert, D., Wanzer, L., Johnson, H., Alguire, K., Dillon, D., Welder, M. D., & Romano, C. (2019). Operational Readiness: Redesigning Advanced Practice Registered Nurse (APRN) Curriculum for an Evolving Battlefield. Military Medicine184(3-4), e156–e162. https://doi.org/10.1093/milmed/usy269 

  • DeForest, C. A., Blackman, V., Alex, J. E., Reeves, L., Mora, A., Perez, C., Maddry, J., Selby, D., & Walrath, B. (2018). An Evaluation of Navy En Route Care Training Using a High-Fidelity Medical Simulation Scenario of Interfacility Patient Transport. Military Medicine183(9-10), e383–e391. https://doi.org/10.1093/milmed/usx129 

  • Health.mil. (2024, March 18). Defense Medical Readiness Training Institute. https://health.mil/Military-Health-Topics/Education-and-Training/DMRTI

  • Joint Trauma System. (2024, March 12). The Department of Defense Center of Excellence for Trauma. Clinical Practice Guidelines. https://jts.health.mil/index.cfm/PI_CPGs/cpgs

  • Spott, M. A., Burelison, D. R., Kurkowski, C. R., & Stockinger, Z. T. (2018). JTS CPG development process. Military Medicine183(suppl_2), 12-14. https://doi.org/10.1093/milmed/usy113

  • TriService Nursing Research Program.(n.d.) TSNRP Publications. Retrieved March 21, 2024, from https://www.triservicenurse.org/publications

  • Wilson, K. E., Vasek, M., VanFosson, C. A., Flarity, K., Mann-Salinas, E., Gillespie, K., Keenan, S., Fisher, A. D., April, M. D., & Schauer, S. G. (2022). An Assessment of Nursing Skills Required for Sustaining a Casualty during Prolonged Casualty Care: Implications for Training and Preparing for the Next Major War. Medical Journal (Fort Sam Houston, Tex.)Per 22-04-05-06(Per 22-04-05-06), 83–88.

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